OSCE IUD KONSELING/ COC KONSELING

Intro to Board Good morning, Doctor, I am ____ one of the participants of PPDS selection
program.
Permission to read the text.
Intro to Pts Good morning, Ma’am, my name is ____, I am the doctor in charge today.
Is there anything I can help you with?
Determine the There are several contraceptive methods, it depends on your goal, whether you  Delay: COC or injection
goal want to delay your pregnancy, you want to postpone your next pregnancy, or you  Postpone: implants or IUDs
don’t wish to get pregnant anymore in the future.
Have you recently given birth to your child? Are you breastfeeding now?
Do you have any children now?
Do you wish to have more children in the future?
IUDs
Screening Well, if you choose IUD, I have some questions to ask to you:
Are you sure you are not in a pregnant state? Have you taken any pregnancy tests?
Have you ever been diagnosed with pelvic inflammatory disorder or uterine
anomaly?
How it works IUD is a small, flexible made of plastic device that is inserted to your uterus
through your cervix.
They work basically to prevent the sperm and egg meet, so hopefully fertilization
will not happen.
Types of IUD There are two types of IUD, the one that is covered with hormones or copper.
The one with hormones will cause your cervical mucus to thicken, thus preventing
the sperm to go through into your womb cavity. The copper one will cause sterile
inflammation that can alter the sperm mobility.
Both also act as a physical barrier to prevent the sperm to meet the egg.
Effectiveness Which one is most effective?
Both are effective up to 99%. Only less than 1 pregnancy per 100 women over the
first year using IUD.

Is there any IUD 100% effective?

There is no contraceptive method that guarantee 100% success. But IUD is
considerably a contraceptive method that give high success rate.
Advantages Can be used for a long time
Highly effective
The return of fertility after IUD removed is immediately
Disadvantages Need healthcare professional to insert the IUD If bleeding cause drop in Hb:
Do not give protection against STD Evaluate, remove the IUD, search
There can be prolong bleeding and heavier cramps in the first 3-6 months after the for other contraceptive method
IUD inserted

Why can be prolonged and heavier cramps in the first 3-6 months after the IUD
inserted?
Since IUD is detected as a foreign object by your body, the first months the body
will do some adjustments first. After 3 or 6 months, your period will come back to
normal.
(sterile inflammation cause the blood vessel to dilate  resulting in heavier
bleeding)
How long can I It depends on the type and brand of the IUD. Mirena 7 tahun
use the IUD Most of the IUDS can be used for 7 to 10 years. NOVA T 380 (copper) 10 tahun
andalan (copper) TCU 380 10th
375 = 5th
Time of insertion IUD can be inserted at any time of the month, as long as you are sure you are not
pregnant. I advise you take a pregnancy test before you get your IUD.
Or, you can get your IUD inserted at the second or third day of menstrual period.
During that time, your cervix will dilate a bit, so hopefully the insertion will be
easier. We also hope the discomfort from your menstrual period will mask the
discomfort from the IUD insertion procedure.
Control and what You can come anytime between 3-6 weeks after the IUD insertion. Pain in the lower abdomen to the
to expect You can also feel your IUD string yourself, especially after the first period after back
using the IUD. Wash your hand, do squat, and insert your finger to your vagina and Vaginal discharge
feel the string. You should come back if you cannot feel the IUD string, or you feel Fever with chills
the hard part of the IUD. We will do some examinations for further evaluation.
Or if you feel any of these symptoms, you can also come earlier.
Discharge What if I am having a vaginal discharge right now?
As long as the discharge is not smelly, itchy, or burning, and transparent in color,
you can still get the IUD inserted. But if you feel the discharge is smelly and itchy,
I suggest that you get your vaginal discharge tested and treated first.
Strings can’t be There are several possibilities why your IUD string can’t be felt.
felt The string may be coiled to inside your uterus, of the IUD can be expelled without
you noticing it, or the IUD maybe embedded to your womb. We have to do more
examinations for further evaluation.
 I heard that the IUD can expel by itself?
There are some conditions that can cause the IUD to expel, like if you tend to have
heavier menstrual bleeding, our you get your IUD inserted between 48 hours to 4
weeks after you give birth
Sex myth I heart some myths that IUD string can cause some discomfort during sex?
The IUD string is essential to get the IUD removed.
However, the string is very soft, and it will only 2-3cms from your cervix.
Hopefully with the right procedure, we will minimize the discomfort so you won’t
feel any discomfort while engaging in sexual activities.
ASK Is there anything you want to ask?
COCs
Screening Well, if you choose COCs, I have some questions to ask to you: Rifampicin
Do you have any high blood pressure, heart diseases, any metabolic diseases? Fenitoin
Do you smoke? Barbiturat
Is there any medication that you take? Griseofulvin
Tricilyc antidepresant
Ampicilin/ penisilin
Tetrasiklin
(make COC less effective)
Types of pills Monofasik: 21 +7, E dan P dosis
sama
Bifasik 21+7; 21 E dan P, 2 dosis
beda
Trifasik 21 +7; 21 E P, 3 dosis
berbeda
How it works The pills contain hormones that will prevent you to release the egg.
Effectiveness It is highly effective, less than 1 pregnancy per 100 women using COCs over the
first year.
As long as you take the pill regularly and don’t miss any pill, hopefully the pill will
work effectively to prevent the release of the egg.
Advantages Highly effective
Can be stopped at any time without a provider’s help
Easy to use
Regular menstrual cycle
Return of fertility is immediately after stopping the pill
Do not interfere with sexual activity
Disadvantages Should be taken every day at the same time – you may get bored How to avoid dizziness, nausea
Do not protect from STD etc.?
May cause dizziness, nausea, light headed Take the pill before bed time
(In Indonesia – quite expensive)
How to take the There are two types of pills, the placebo and the hormones one.
pill The pill should be taken at the same time of every day.
You can start taking the pill at the first day of your menstrual period, take the
placebo pill/ the yellow-colored pill/ the bigger pill for 7 days, and then continue to
take the smaller pills.
Or if you just finished your menstrual period, you can start from the hormone’s
pills, after you finish the whole hormonal pills, ditch the placebo pills and start
from the new package.
Forget to take the If you forget to take one pill, take the forgotten pill immediately, and continue the
pill pill as it should.
If you forget to take two pills or more, take two pills every day until your pill
continue as the schedule/ as it should. Meanwhile, you should avoid having sex or
use condom until you take the pill as the schedule should be.
Acne Acne usually improves with COC use, but for some women it may get worse.
Weight gain COC does not cause weight gain or weight loss. Some people may have changes in
their daily habit that incidentally happen parallel while taking the pill.
Because changes in weight are so common, many women think that the weight
changes happen due to the COC. However, after stopping the COC, usually any
weight changes that happen will reverse.